Graduate Student Tuition Remission Form
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Graduate Student
Temple
TUITION REMISSION
University
This tuition remission form, when properly completed and authorized, can be used to pay your tuition in voice.
This form must be completed in full and an award letter attached in order to credit the student’s
account. Forms should be submitted to the Bursar’s Office on your campus . A new form must be submitted
for each semester. Please retain a copy for your file.
PLEASE PRINT
Semester
School
School Year
TUid
Full Time
Credit Hours
Tuition Amount
Part Time
__________
$___________
Student’s Name:________________________________
PA Resident
Address: ______________________________________
Non-PA Resident
Graduate
City, State & Zip:________________________________
Non-US Resident
Professional
Telephone #: __________________________________
Please complete in full:
Program
Fund
Org
Program
Amount
Please Answer the following:
Graduate Student -
The purpose for granting tuition remission is:
Research
Academic Internships
Assistantship - services required:
Graduate Student -
Teaching
Teaching
Research
Academic Internship
Other _______________________
Allocation of Tuition Remission:
Tuition Amount:
____________
Computer Fee
____________
Other Fees
____________
*please specify
____________
____________
____________
Total Remission:
By signing this form, I agree that the information abo ve is correct.
Student Signature__________________________
Department Head:________________________
Print Name ________________________ Date ____________
Authorizing Signature: ____________________
Print Name ________________________ Date ____________
OFFICIAL USE ONLY
Taxability
ISIS
Award Letter
Is T/R Taxable
FTRN
Amount
Date
Yes
Yes
No
No Approval ________
Form #351 (Rev. 10/24/2013)
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